Paediatric Clinical Psychology - information for referrers

Dr Kirstin Sharp and Dr Jenny Wright are Clinical Psychologists based in the Child Health Department at the Borders General Hospital. We job share one full time post between us. 

We both work part-time and divide our caseload geographically. Jenny works Monday and Tuesday and covers Peebles areas and Hawick. Kirstin works Tuesday, Wednesday and  Thursday  and covers Kelso, Jedburgh and Berwickshire areas. We both share referrals in the central Borders areas (Galashiels, Selkirk, Melrose). We also might have Trainee Psychologists working with us on placement. 

Paediatric clinical psychologists work with children primarily in relation to their health and our role is to work with children and young people that are experiencing some health difficulty, illness, medically unexplained symptoms or chronic condition and whose emotional or behavioural difficulties are related to their health or symptoms. 

Children and young people with medical conditions, and their families, can experience a number of challenges when trying to adjust and cope. Research has indicated between 10-40% of children with chronic illness may face some emotional difficulty at some point in their treatment. It can be difficult managing treatment alongside everyday activities, and it is normal to have times of difficulty with this. 

Paediatric clinical psychologists work with children, young people and families with a range of physical/ chronic illness to help cope with the psychological demands of illness and associated stresses of medical treatment and hospital care.                                                             

Our aim is to try and help adjust and manage illness and the impact on children's lives. We can also try and help with psychological difficulties which could be adversely impacting upon ability to fully benefit from medical care/ treatment. 

Sometimes children, young people and families find it useful to speak to someone about what they are going through. It can be beneficial to have a professional to speak to that is aware of the medical demands experienced, however, not directly involved in clinical care. Sometimes it can also be beneficial for a child/ young person to have someone outwith their family to talk to. 

Some of the types of difficulty we might see are: 

• helping manage pain and fatigue 
• helping to deal with anxiety about invasive procedures or taking medicines 
• helping develop ways of managing regular treatment or procedures or coping with side effects of treatment. 
• helping assess and support when feeling low or anxious about diagnosis or treatment 
• assessing how some illness or treatment might affect learning, concentration or memory 
• helping prepare for planned medical procedures 
• thinking about choices around treatment 
• any behaviour and emotional difficulties associated with chronic illness 
• exploring the impact of diagnosis/ treatment on self esteem, confidence or body image 
• supporting through transitions 
• family support around coping, adjustment and parenting/ living with a child with a chronic illness 
• family support to help with adjustment and coping when young babies are in SCBU or children are inpatients or receiving lengthy hospitalisation 

We offer psychological assessment, intervention and support as well as consultation about cases. 

We generally would not see children and families whose problems are not associated with their medical condition or predate diagnosis (e.g. toileting, sleep, mood difficulties, ADHD, autism if the issues are unrelated to the health problem). 

We would also not generally see children and families with severe emotional difficulties, significant mental health problems or substance misuse, as there are more appropriate services for these patients. Any urgent concerns regarding self harm, risk or child protection would be referred to other emergency services as normal. 

We would tend not to see children that are already involved with another mental health worker for instance is receiving input from CAMHS. 

We will see children and young people together with their family and also individually . Appointments generally take up to an hour, or more, to be able to have a chance to talk in depth about difficulties. Sessions generally involve talking and, depending on the age of the child, may include play, drawing and keeping diaries and homework tasks. 

Appointments are generally arranged at the BGH or health centres. Where possible psychology appointments are scheduled to fit in with attendance at hospital or other outpatient/ ambulatory care clinics. 

Information discussed in sessions is confidential. However, some information may be shared with others, as appropriate, to enable the best health outcomes for the child and this will be first discussed with the child/ young person for consent. Any concerns about harm are paramount and would be exempt from confidentiality agreements. 

Written feedback and reports will be provided regarding input and sent to referrer and usually GP's and Paediatricians. 

We may work jointly with other colleagues already involved with the family and can also link with specialist services such as other hospitals. 

Any child or young person, living in the Borders, currently attending Paediatric Health Services can be referred to the Paediatric Clinical Psychology Service by a health professional working with the family. We will work with young people up to the point that they transition to adult health services or up their 18th birthday. We can liaise with other services in situations where it is unclear who should be best to see the young person (e.g. CAMHS, adult teams). 

A child/ young person can also ask themselves if they wish to be seen. 

Referrals should be discussed and agreed first with the child and family, so they are aware of why we will be meeting them and consent to this. 

Referrals can be discussed with us first if desired. 

All referrals should be made in writing (a brief letter with reason for referral and relevant background and medical information) and sent to: 

Paediatric Clinical Psychology 

Andrew Lang Unit Viewfield Lane 

Selkirk TD7 4LJ 

Telephone:  01750 23715 

After a referral has been received we will review the referral letter whether it is appropriate for our service and either allocate a psychologist or place on a waiting list. Depending on demand at any given time we usually have a brief waiting list. Our administration is done from the CAMHS secretaries and letters and communication come from the Andrew Lang Unit. 

Once an appointment slot is available the psychologist will send an appointment letter direct to the family. We use EMIS electronic records to note our contact. All relevant paperwork will usually be copied into the medical file in update letters to the relevant Paediatrician. 

In the occasion that appointments are not attended we will offer families the chance to let us know if they still wish to be seen and they can be offered another time. If we do not hear further after this we tend to assume they do not wish to be seen and we will discharge. 

We will write a letter back to the referrer and usually copied to GP and any other relevant professionals with brief details of our initial assessment and a plan of any psychological work.